台灣 專科 護理 師 學刊最新文献

{"title":"一位66歲女性以肺腫塊表現的白血病髓外肺浸潤案例","authors":"蔡惠婷 蔡惠婷, 李榮真 Hui-Ting Tsai","doi":"10.53106/2410325x2023081001006","DOIUrl":"https://doi.org/10.53106/2410325x2023081001006","url":null,"abstract":"<p>白血病髓外肺浸潤是一種罕見的臨床疾病，因其胸部X光和臨床表徵不具特異性，診斷困難往往延誤適當的治療。本案例為66歲女性，因發燒、咳嗽、活動後呼吸急促就醫，胸部電腦斷層顯示疑似肺膿瘍。因初步診斷為肺膿瘍故行豬尾巴導管置放術併切片檢查，病理報告僅顯示慢性發炎，且以多線抗生素藥物治療。爾後因周邊血液出現芽細胞，經骨髓切片診斷為急性骨髓性白血病，隨著病人發燒未改善，醫療團隊針對肺膿瘍，安排胸腔鏡行右上葉切除、右下葉楔狀切除及肺剝離術，最終肺組織病理報告確診為急性骨髓性白血病併髓外肺浸潤。經此案例予臨床重要省思是當病人反覆發燒且電腦斷層影像疑似肺膿瘍生成，抗生素藥物治療效果不彰，必須將白血病併髓外肺浸潤列入鑑別診斷，且一經確診為白血病髓外肺浸潤，應及早針對白血病疾病治療， 以免誤判病人肺部有感染情形，而延後癌症治療，增加病人死亡風險。</p> <p>&amp;nbsp;</p><p>Acute myeloid leukemia with extramedullary pulmonary infiltration is a rare clinical case. Without specific clinical manifestations and imaging features, the diagnosis is often challenging, leading to a delay in treatment. The case is of a 66-year-old female patient, who visited the emergency department due to cough, fever and exertional dyspnea. Due to recurrent fever, a chest CT scan was performed and revealed lung abscess. Based on the initial diagnosis of lung abscess, pigtail catheter placement and bronchial biopsy were performed. The pathological report showed only chronic inflammation. Thus, the patient was treated with multiple antibiotics and antifungals. Due to the detection of blast cells in the peripheral blood via the complete blood count, bone marrow biopsy was performed and then acute myeloid leukemia was confirmed. However, the recurrent fever continued for one month. The medical team arranged thoracoscopy for right upper lobe resection, right lower lobe wedge resection, and lung pneumonolysis for the lung abscess. Pulmonary histopathological report eventually confirmed acute myeloid leukemia with extramedullary pulmonary infiltration. This case suggested that when a patient has recurrent fever and the CT image shows suspected lung abscess formation, antibiotic treatment may not be effective. Extramedullary infiltration of leukemia should be suspected in the differential diagnosis. Once confirmed as extramedullary pulmonary infiltration of leukemia, leukemia related treatment should be provided as soon as possible. The delay of cancer treatment, which may increase the risk of mortality.</p> <p>&amp;nbsp;</p>","PeriodicalId":491524,"journal":{"name":"台灣 專科 護理 師 學刊","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135002198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"肥胖COVID-19病人之早期治療與照護","authors":"林帝芬 林帝芬, 胡慧蘭 胡慧蘭, 胡佳潁 胡佳潁","doi":"10.53106/2410325x2023081001003","DOIUrl":"https://doi.org/10.53106/2410325x2023081001003","url":null,"abstract":"<p>嚴重特殊傳染性肺炎（COVID-19）造成整個世界健康與經濟重大衝擊與危機，尤其是高齡和慢性病患者更容易產生預後合併症、重症和死亡。然而流行病學證據顯示肥胖者，即使年輕（< 65歲），不論有無慢性疾病史，較非肥胖者易感染SARS-CoV-2病毒和發生感染後的重症與死亡。因此本文整理肥胖者較易感染SARS-CoV-2 的生病理機轉、口服抗病毒藥物（Paxlovid &amp; Molnupiravir）使用相關知識、慢性病藥物調整和居家照護時的生活型態，包括營養攝取及運動方式建議，期待第一線的專科護理師對「肥胖」這個危險因子具有敏感性，可以收集相關病史與身體檢查評估資料，不論在口服抗病毒或慢性病藥物（尤其是高血壓、高血脂和抗凝劑等）使用與生活型態調整、營養補充都能與醫師討論做出最有利的建議，以期早期治療COVID-19，避免重症和死亡的發生。</p> <p>&amp;nbsp;</p><p>The COVID-19 pandemic severely impacted the health and economics of the entire world since De&amp;shy;cember 2019, particularly to the elderly and people with chronic diseases for a higher possibility of aggravations, complications and even death. However, the epidemiological evidence showed that obese people are prone to SARS-CoV-2 infection and post-COVID complications. This review reported the mechanism of SARS-CoV-2 entry into fat cells, COVID-19 medications (Paxlovid &amp; Molnupiravir) and treatments, chronic disease (e.g. hypertension, hyperlipidemia, and anticoagulation etc.) manage&amp;shy;ment, and lifestyle (diet and exercise) modification. Nurse practitioners should consider obese as a significant risk factor while designing management plans with doctors and initiate the anti-COVID-19 treatment plan as soon as possible for complication prevention among obese cases.</p> <p>&amp;nbsp;</p>","PeriodicalId":491524,"journal":{"name":"台灣 專科 護理 師 學刊","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135003722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"一位42歲男性接受兩階段肝切除術後發燒表現","authors":"廖婉君 廖婉君, 黃敦頌 Wan-Chun Liao, 林俊昌 Tun-Sung Huang","doi":"10.53106/2410325x2023081001008","DOIUrl":"https://doi.org/10.53106/2410325x2023081001008","url":null,"abstract":"<p>肝癌為國人不可忽視的重要健康議題，其治療方式包括手術治療及非手術治療。接受肝臟切除手術常見的併發症有肝衰竭、出血、急性腎損傷、膽汁滲漏及肋膜積液等，若介入治療時機適當，能減少嚴重併發症而降低生命危險，故術後的照護為重要的目標。本個案是一位42歲男性，為B型肝炎帶原，因診斷為巨大肝臟腫瘤接受兩階段肝切除手術，於第二階段術後第13天出現高燒、引流液呈黃褐色液，相關臆測診斷有腹內感染及肋膜積水等，一一排除後，經由腹部超音波及胸部X光檢查，確立有膽汁滲漏及肋膜積液等複雜性併發症，透過給予胸腔穿刺、腹部引流管置放及抗生素治療一週後病情穩定且併發症獲得控制，照護期間為2020年7月11日至2020年8月10日，期望藉此經驗能做為日後照護此類個案之參考。</p> <p>&amp;nbsp;</p><p>Hepatocellular carcinoma is undoubtedly a significant health issue. The medical treatments of the dis&amp;shy;ease include operative and non-operative management. The most common complications after hepatic resection are liver failure, hemorrhage, acute kidney injuries, bile leakage, and pleural effusion. How&amp;shy;ever, the possibility of severe complications could be decreased if proper postoperative care is provid&amp;shy;ed. This can, meanwhile, reduce the threats to lives. Thus, careful postoperative care plays a vital role. The case in this study is a forty-two-year-old male hepatitis B carrier. He was diagnosed with giant hepatocellular carcinoma after clinical physical examinations and imaging tests and then received a two-stage hepatectomy. He had a postoperative fever on the thirteenth day after liver resection with brownish-yellow fluid from drainage. Therefore, postoperative intra-abdominal infection with pleural effusion were suspected. After receiving an abdominal ultrasound and chest X-ray, it was confirmed that he had complications of bile leakage and pleural effusion. His condition was well-controlled after a week under the treatment of thoracentesis, abdominal drainage as well as antibiotics. The period of postoperative care was provided from July 11 to August 10, 2020. This case could be a reference for taking care of patients with similar issues.</p> <p>&amp;nbsp;</p>","PeriodicalId":491524,"journal":{"name":"台灣 專科 護理 師 學刊","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135001913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"一位78歲男性以膝關節疼痛及反覆發燒表現","authors":"陳巧榕 陳巧榕, 陳佳德 Chiao-Jung Chen, 孫健耀 Chia-Te Chen","doi":"10.53106/2410325x2023081001007","DOIUrl":"https://doi.org/10.53106/2410325x2023081001007","url":null,"abstract":"<p>發燒為常見臨床症狀，本案例是一位78歲末期腎臟疾病接受長期血液透析治療男性，近一個月曾發生永久性透析導管感染合併金黃色葡萄球菌菌血症，此次因左膝關節疼痛就醫，理學檢查發現關節發熱腫脹，診斷感染性關節炎入院治療， 關節液及血液培養顯示金黃色葡萄球菌，在抗生素治療及行左膝切除關節成形術後仍反覆發燒， 經由專科護理師完整病史收集、全身理學檢查、實驗室檢驗結果，排除導管感染及心內膜炎等相關鑑別診斷，電腦斷層血管攝影顯示囊狀主動脈合併周圍積液確診為感染性動脈瘤。因年紀大合併多種慢性共病（塵肺症、慢性阻塞性肺病及末期腎臟疾病等），在家屬考量動脈瘤切除、結紮及血管重建手術利弊後決定採保守治療（6週Piperacillin-Tazobactam和Vancomycin抗生素靜脈注射療程），發燒及低血壓狀況改善，且血液培養亦未發現新的感染。臨床上，當病人主訴反覆發燒合併金黃色葡萄球菌菌血症時，根據我們的案例及文獻回顧，應強調以焦點式理學檢查積極探查可能的轉移性感染（包括：導管感染、軟組織感染、感染性關節炎、心內膜炎及感染性動脈瘤等），輔以影像學檢查。以此案例提升專科護理師於類似複雜案例時的照顧能力，利於醫療團隊即早確定診斷及介入治療，以降低延遲治療對於脆弱老年病人帶來負面影響。</p> <p>&amp;nbsp;</p><p>Fever is a common symptom in clinical practice. A 78-year-old male with end-stage kidney disease (ESKD) who underwent hemodialysis was admitted due to left knee pain. Upon physical examination, there were signs of joint heat, swelling, and tenderness in addition to febrile state, suggesting a diag&amp;shy;nosis of septic arthritis. Staphylococcus aureus (SA) was later identified in both the synovial fluid and blood culture. However, the patient experienced recurrent fever despite receiving appropriate antimi&amp;shy;crobial treatment and undergoing left knee resectional arthroplasty. To rule out other potential diagno&amp;shy;ses related to SA bacteremia, a thorough evaluation involving medical history, physical examination, and laboratory tests was conducted. The computed tomography angiography revealed the presence of a saccular aortic aneurysm with perianeurysmal fluid collection, confirming a diagnosis of mycotic an&amp;shy;eurysm. The patient and his family carefully considered the advantages and disadvantages of surgical options, such as aneurysm excision, ligation, or vessel reconstruction. Under the considerations of the age and underlying comorbidities such as pneumoconiosis, chronic obstructive pulmonary disease, and ESKD, conservative treatment was performed (a 6-week course of intravenous piperacillin-tazobactam and vancomycin). The fever and hypotension gradually subsided, and there was no evidence of blood&amp;shy;stream infection. Based on our case and extensive literature reviews, it is crucial to actively evaluate metastatic complications, including infective endocarditis, catheter infection, septic arthritis, and my&amp;shy;cotic aneurysm, among patients who present with persistent fever and concurrent SA bacteremia. This case aims to enhance the abilities of nurse practitioners in conducting comprehensive assessments, providing vital information to the medical team, facilitating accurate diagnoses, timely interventions, and ultimately reducing the adverse impact of delayed treatment in vulnerable older adults.</p> <p>&amp;nbsp;</p>","PeriodicalId":491524,"journal":{"name":"台灣 專科 護理 師 學刊","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135003718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"一位59歲女性以雙下肢水腫表現","authors":"紀惠雅 紀惠雅, 呂婧希 Hui-Ya Chi, 塗昆樺 Jing-Xi Lu","doi":"10.53106/2410325x2023081001009","DOIUrl":"https://doi.org/10.53106/2410325x2023081001009","url":null,"abstract":"<p>有許多病因會造成雙下肢水腫，心臟、肝臟、腎臟等相關疾病首先需被排除。本案例為一位罹患甲狀腺亢進的59歲女性、規則服用丙硫氧嘧啶（Propylthiouracil, PTU）兩年，以雙下肢水腫為最初表現，伴隨有血尿、蛋白尿及腎功能損傷，初始臆測是不明原因的腎絲球腎炎，經檢驗發現抗嗜中性球細胞質抗體（Antineutrophil Cytoplasmic Autoantibodies, ANCA）呈陽性反應， 最終透過腎臟切片，證實為PTU相關ANCA血管炎，予以停止PTU、給予類固醇治療後，腎功能獲得改善。針對此類個案無法以症狀及檢驗檢查確立診斷時，需安排被侵犯部位的切片檢查來協助診斷，當確定是藥物相關ANCA血管炎時， 應立即停藥，避免造成致命性的傷害。</p> <p>&amp;nbsp;</p><p>Many diseases may cause bilateral lower extremity edema. Diseases related to the heart, liver, and kidney shall be excluded first. The case of this study was a women aged 59 years with hyperthyroid&amp;shy;ism. The patient regularly took propylthiouracil (PTU) for 2 years. Bilateral lower extremity edema emerged as the first symptom, followed by hematuria, proteinuria, and impaired kidney functions. Initially, the medical team assumed the cause was glomerulonephritis with an unknown cause. After examination, the team discovered the patient was antineutrophil cytoplasmic autoantibodies (ANCA) positive. Through kidney biopsy, the team confirmed that the cause was PTU-related ANCA vascu&amp;shy;litis. Therefore the delivery of PTU was discontinued, and steroid treatment was administered. The patient&amp;rsquo;s kidney functions gradually improved. In similar cases where diagnosis cannot be confirmed through symptom interpretations or general examinations, biopsy of the infected area should be per&amp;shy;formed to confirm the diagnosis of the cause. When drug-related ANCA vasculitis is confirmed, the delivery of medicine must be suspended immediately to avoid further lethal damage.</p> <p>&amp;nbsp;</p>","PeriodicalId":491524,"journal":{"name":"台灣 專科 護理 師 學刊","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135003721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"專科護理師之執業困境與未來修法建議","authors":"邱慧洳 邱慧洳","doi":"10.53106/2410325x2023081001002","DOIUrl":"https://doi.org/10.53106/2410325x2023081001002","url":null,"abstract":"<p>專科護理師執業範圍於103年8月立法後，專科護理師執業範圍較為明確，但專科護理師於臨床實務中仍面臨若干執業困境，執業困境一為專科護理師依預立醫療流程可開立醫囑，其法源依據為「專科護理師於醫師監督下執行醫療業務辦法」，但專科護理師於醫師指示下開立醫囑，於臨床實務上，亦屬常見，但卻欠缺法源依據。衛生福利部於112年2月公告「專科護理師於醫師監督下執行醫療業務辦法」之修正草案，此修正草案規範預立醫療流程適用於社區居家情境，執業困境二為預立醫療流程適用於社區居家情境， 是否有牴觸醫師法第11條規定之虞？再者，修正草案對預立醫療流程制定程序之規範，亦非清楚，可能造成預立醫療流程於社區居家情境之適用，窒礙難行。本文針對此等困境與問題提出建議，希冀健全專科護理師執業範圍之法制，避免專科護理師觸法，確保其執業安全，並提升病人之照護安全與品質。</p> <p>&amp;nbsp;</p><p>Since the Nursing Personnel Act was amended in August 2014, the scope of practice of nurse practi&amp;shy;tioners is relatively clear, but nurse practitioners still face some difficulties in clinical practice. The first difficulty is that based on the &amp;ldquo; Regulations Governing Nurse Practitioners Carrying out Medical Activities under the Supervision of a Physician &amp;ldquo; nurse practitioners can prescribe medical orders ac&amp;shy;cording to the pre-established medical procedures. However, it is common for nurse practitioners to prescribe medical orders under the oral instructions of physicians in clinical practice without prescribe medical orders, and the action lacks any legal foundation. In February 2023, the Ministry of Health and Welfare announced the amendments to the &amp;ldquo; The Practice of Nurse Practitioners Performing Medical Services Under the Supervision of Physicians &amp;ldquo;. This amendment regulates that the pre-estab&amp;shy;lished medical procedure is applicable to the community home care situation. Thus, the second prac&amp;shy;tice difficulty is as followed: Is there any risk of violating the provisions of Article 11 of the Physician Law? Furthermore, the amendments are not clear about the formulating process of the pre-established medical procedures, which may hinder the application of the pre-established medical procedures in the community home care situation. This paper puts forward suggestions for these dilemmas and prob&amp;shy;lems, hoping to complete the legal perspectives of nurse practitioners&amp;rsquo; scope of practice, to prevent nurse practitioners from breaking the law, to ensure the safety of their practice, and to improve the safety and quality of care for patients.</p> <p>&amp;nbsp;</p>","PeriodicalId":491524,"journal":{"name":"台灣 專科 護理 師 學刊","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135002197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"一位30歲孕婦於生產時以意識改變為表現","authors":"曾巧莉 曾巧莉","doi":"10.53106/2410325x2023081001005","DOIUrl":"https://doi.org/10.53106/2410325x2023081001005","url":null,"abstract":"<p>懷孕婦女併發腦血管意外是罕見的產科急症，其中重要的危險因素是子癲前症。本文案例是一位 30 歲初次懷孕39週又3天婦女，無特殊疾病史， 入院待產時出現高血壓合併蛋白尿，被診斷為子癲前症，於自然生產時發生嗜睡及意識改變。醫療團隊藉由神經學檢查及電腦斷層掃描診斷為腦梗塞，立即給予血栓溶解劑治療。治療中密切監測覺察病人有新的神經學異常，立即再度執行電腦斷層掃描，發現後續發生的右側大腦出血，緊急行顱骨切開手術清除血塊。術後病人仍有明顯的左側偏癱，經過積極的復健治療，出院時左上肢肌力3分，左下肢肌力4分，可使用拐杖步行移動。對於子癲前症的高危險妊娠，從待產、生產以至產後過程，均應密切監測血壓及神經學變化，如併發嗜睡及意識改變時，應快速及正確做相關腦血管疾病的鑑別診斷，早期診斷發現，預防惡化再發生，期能在中風黃金時間三小時內及早治療，降低病人殘障、失能及死亡的機率。</p> <p>&amp;nbsp;</p><p>Stroke is an uncommon but serious potential complication of pregnancy. A 30-year-old woman was in her 39+3 weeks of first pregnancy without any past medical history . After admission, she was diag&amp;shy;nosed as preeclampsia due to hypertension with p1roteinuria. Drowsiness and changes of conscious&amp;shy;ness occurred during delivery. The neurological examination and brain CT scan revealed cerebral infarction and thrombolysis was performed. During the treatment new neurological abnormalities was found, CT scan was immediately performed again. Right cerebral hemorrhage was confirmed and an emergency craniotomy was performed. After the operation, the patient still suffered from obvious left hemiplegia. After active rehabilitation treatment, the muscle strength of the left upper limb was 3 points and the muscle strength of the left lower limb was 4 points at the time of discharge, and she could walk with crutches. For high-risk pregnancy with preeclampsia, blood pressure and neurological changes should be closely monitored during labor, delivery, and postpartum. If symptoms as drowsi&amp;shy;ness and changes in consciousness are shown, the differential diagnosis of related cerebrovascular dis&amp;shy;eases should be made quickly and correctly. To prevent the recurrence of deterioration, early treatment is expected within three hours of the prime time of stroke. The probability of handicapped, disability and death of patients can be reduced.</p> <p>&amp;nbsp;</p>","PeriodicalId":491524,"journal":{"name":"台灣 專科 護理 師 學刊","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135001914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"提升初診斷食道癌病人護理指導之完整率","authors":"黃敏勤 黃敏勤, 蔡惠婷 Min-Chin Huang, 賴郁蓓 Hui-Ting Tsai, 周碧玲 Yu-Bei Lai","doi":"10.53106/2410325x2023081001004","DOIUrl":"https://doi.org/10.53106/2410325x2023081001004","url":null,"abstract":"<p>背景：初診斷食道癌病人，因生理上遭受進食功能與營養缺失，其角色及情緒功能受影響易出現憂鬱或焦慮，而導致整體生活品質下降。在診斷初期，病人有高度照護資訊的需求，但對於短時間的大量信息常造成吸收負荷。連貫完整的護理指導可促進病人對護理指導之理解程度，進而提升自我照顧能力與生活品質。本單位初診斷食道癌病人陸續有檢查或手術延遲、食物哽塞或進食管路阻塞情形， 於2020年3月2日至3月20日，統計單位對其護理指導完整率僅62.5%，影響照護品質，故引發專案動機</p> <p>目的：提升護理人員對初診斷食道癌病人護理指導完整率達97.5%。</p> <p>解決方案：分析原因為護理人員之疾病認知不足、衛教解說耗時、無追蹤機制致重複指導。病人部份包括訊息眾多龐雜影響衛教效率、家屬輪替致指導中斷與不完整。此外尚包括教育資源未符合指導需求、來源與資訊未統合、缺乏追蹤機制等。透過舉辦在職教育、製作衛教卡通圖及工作車桌曆、錄製衛教影片並製作QR Code連結觀看、發放照護手冊及簡易化放療照護包、設計衛教進度檢核表與查核表等策略提升完整率。</p> <p>結果：透過多元護理指導工具及衛教資源整合可提升連貫完整的護理指導。除了增進病人疾病認知及自我照護能力外，亦使醫療滿意度提升，並促進照護品質。</p> <p> </p><p>Background:Patients with newly diagnosed esophageal cancer often suffer from depression and anxiety due to lim&amp;shy;ited oral intake and malnutrition, which affects their physical and emotional function, resulting in a decline in their quality of life. Patients have a high demand for self-care information in the early stages of diagnosis. However, getting large amounts of information in a short time often creates tremendous pressure for the patients. Coherent and compre&amp;shy;hensive nursing guidance can increase the understanding of nursing guidance which further improvs patients&amp;rsquo; self-care ability. Delayed examination or surgery, choking, or obstruction of the feeding route occur frequently on patients with esophageal cancer initially diagnosed in our unit. A team was established to improve the low nursing guidance com&amp;shy;pletion rate (62.5%).</p> <p>Purpose: To improve the completion rate of nursing guidance for newly diagnosed esophageal cancer patients from 62.5% to 97.5%.</p> <p>Strategic procedure: Inadequate nursing knowledge, insufficient continuity of health education, and a lack of after&amp;shy;ward follow-ups in delivering information are identified as main obstacles for medical providers. As for patients, main obstacles include massive information and interrupted or incomplete instruction due to family rotation. In addition, the inconsistent resources and content of the supplementary teaching materials needed to be carefully complied to meet the needs and a health education tracking system needed to be set up as well. As a result, specific strategies were developed to successfully decrease the rate of feeding route obstruction. The strategic procedures included consolidat&amp;shy;ing in-service education, remodeling teaching materials, creating a useful pictorial calendar and work cards, making instructor videos, creating QR code links for teaching materials, and designing standardized education protocols and checklists.</p> <p>Outcomes Evaluation: The completion rate of nursing guidance increased to 98.2%.</p> <p>Conclusions: Coherent and comprehensive nursing guidance was created by integrating multiple nursing guidance tools and health education materials. In addition to improving patients&amp;rsquo; disease awareness and self-care ability, the im&amp;shy;plementation of the guideline also improves medical satisfaction and the quality of care.</p> <p> </p>","PeriodicalId":491524,"journal":{"name":"台灣 專科 護理 師 學刊","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135003719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"台灣專科護理師預立醫療流程推動的挑戰","authors":"林韋丞 林韋丞, 胡佳潁 胡佳潁","doi":"10.53106/2410325x2023081001001","DOIUrl":"https://doi.org/10.53106/2410325x2023081001001","url":null,"abstract":"<p>專科護理師執行預立醫療流程自104年發布至今已7年多，對於預立醫療流程推動與實務，在臨床上遇到挑戰。筆者身為專科護理師主管，對於預立醫療流程在制定上、資訊化、品質管理與指標建立的困難提出自己的看法，並對於推動上面臨的困境提出建議，期許透過預立醫療流程的推動，能更近一步提升台灣專師的照護品質。</p> <p>&amp;nbsp;</p><p>It has been more than 7 years since the release of the pre-established medical process by nurse prac&amp;shy;titioners in 1994. The promotion and practice of the pre-established medical process has encountered clinical challenges. As the supervisor of a nurse practitioners, the author puts forward his own views on the difficulties in the formulation, informatization, quality management and index establishment of the pre-established medical process and provides suggestions on the difficulties faced in the promotion of pre-established medical process. Hoping that through the promotion of the pre-established medical process can further improve the quality of care provided by nurse practitioners in Taiwan.</p> <p>&amp;nbsp;</p>","PeriodicalId":491524,"journal":{"name":"台灣 專科 護理 師 學刊","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135003720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"一位男性以腹痛黃疸為表現","authors":"陳品嫙 陳品嫙, 張勝雄 Pin-Hsuan Chen","doi":"10.53106/2410325x2023081001010","DOIUrl":"https://doi.org/10.53106/2410325x2023081001010","url":null,"abstract":"<p>腹痛和黃疸於臨床常被臆斷為膽道疾病。本個案因腹痛、黃疸為表現，初期以膽道感染治療， 但因腹痛加劇、血壓下降，緊急安排腹部電腦斷層，發現左葉肝膿瘍已破裂，經皮穿肝引流治療，膿液培養出克雷白氏肺炎桿菌感染，經抽血檢測阿米巴血液凝集試驗發現阿米巴感染，投以標準用藥後病情獲得控制，預後良好。此個案免疫功能正常，但同時罹患阿米巴肝膿瘍合併細菌性肝膿瘍的感染，且發生在肝臟左葉，是極為少見的案例。臨床上個案若以腹痛、黃疸表現，但為免疫功能正常，從事高風險職業、接觸土壤或水源汙染者，應將阿米巴肝膿瘍列入鑑別診斷， 儘快釐清病因，迅速診斷，以免延誤治療先機。</p> <p>&amp;nbsp;</p><p>Abdominal pain and jaundice are often clinically presumed to be symptoms of biliary tract dis&amp;shy;ease. This case who suffered from abdominal pain and jaundice was initially treated as biliary tract infection. However, due to the exacerbation of abdominal pain and the drop in blood pressure, the computed tomography was urgently arranged, and a rupture of abscess on left lobe was found. Per&amp;shy;cutaneous transhepatic drainage of abscess was performed and Klebsiella pneumoniae was cultured. Furthermore, the Amoebic hemagglutination test was positive from the blood. After standard drug treatment, the condition was controlled with good prognosis. However, in immunocompetent patients, the simultaneous occurrence of amebic and bacterial liver abscesses in the left lobe of the liver is very rare. Clinically, an immunocompetent patient presents with abdominal pain and jaundice, and those who have high-risk occupations and are exposed to soil or water pollution, amebic liver abscess should be included in the differential diagnosis. Identifying the causes as soon as possible could lead to early diagnose and to avoid the delays in treatment.</p> <p>&amp;nbsp;</p>","PeriodicalId":491524,"journal":{"name":"台灣 專科 護理 師 學刊","volume":"95 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135001932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}